PNG health minister on malaria cases rise: 'We let our guards down'

MANILA — The rise in malaria cases in Papua New Guinea and re-emergence of polio serve as a wake-up call for the government and international community of the consequences of not investing in health.

From 2009-2014, malaria prevalence in the Pacific island was steadily declining. PNG’s Health Minister Puka Temu attributed this to the intensified malaria control program implemented by the government and country partners in the past decade. In 2014, malaria prevalence in the country saw a significant decline to less than 1 percent from about 11 percent of the population in 2009.

Sixty-eight percent of households in 2014 owned at least two long-lasting insecticidal nets, or LLINs, and while usage rates were less than perfect, there was optimism the country could achieve its target of having 90 percent of households access to the nets in the next few years.

To achieve this, the Papua New Guinea Institute of Medical Research recommended intensifying the campaign on LLIN use. It also recommended the scale-up of home management of malaria, which means treating children with fever in their homes with anti-malarial drugs, to further bring down cases.

But three years after that report, the prevalence of malaria has gone up to 7 percent. This means an increase in cases from 50,309 in 2014 to 432,000 in 2017. Government health funding, meanwhile, dropped 37 percent during that time, according to analysis by Stephen Howes, economics professor at the Crawford Scool of Public Policy, on the DevPolicy Blog.

Speaking to Devex at the conclusion of the 69th regional meeting of the World Health Organization member states in Western Pacific, Health Minister Temu said the rise in cases came when, at government level, “we let our guards down.”

After the five year success came a winding down of key interventions such as the distribution of LLINs, while health funding decreased from both the government and international partners, such as the Global Fund to Fight AIDS, Tuberculosis and Malaria. The timing coincided with a transition phase where the Global Fund expected the government to handle more of its financing for HIV/AIDS, TB, and malaria interventions, he said.

The reduced funding made it difficult for them to stock up on malaria drugs throughout the country.

“Access to the artemisinin-combined therapy was one of our difficulties when we had decreased level of funding so we were not able to provide the right level of ACTs throughout the entire country,” Temu said.

Temu suggested the country’s difficult terrain and community displacement was another factor that hindered them from reaching and expanding the government’s malaria control program.

The health minister stressed that it was “a small spike on the incidence data and therefore we will be able to contain it.”

“Because we’ve had the ability and the availability of our bed nets and drugs, and rapid diagnosis, we should be able to bring this trend back down,” he said.

But the resurgence sheds light on the impact poor transition planning could have. A report this year from the Papua New Guinea Institute of Medical Research stated that the resurgence of malaria “coincided” with a reduction in Global Fund support for the malaria program, a decline in the government’s funding for health, and a reduced availability of ACTs and rapid diagnostic tests across the country.

Devex reached out to the Global Fund for information on its past and current malaria portfolio in PNG, but has not heard back as of this writing. Based on data from the Global Fund’s published grants for malaria on its website, signed grants for malaria control efforts in PNG between 2009-2014 amounted to $91.38 million. From 2015-2017, signed grants totaled $54.88 million. This included the only active Global Fund grant for malaria in PNG.

“The findings in this report suggest that the country has already entered a phase of resurgence following a decrease in the intensity of malaria control efforts. This report should serve as a wake-up call,” according to the institute.

The funding cuts impacted more than malaria increase: PNG is also currently battling a resurgence of polio, 18 years after it was declared polio free. This is the other most visible impact of the cuts in health expenditure and it’s not yet clear how other health areas have been affected by years of reduced health spending.

The health minister said the government has now made health a priority development program, and with that more financial support, although he didn’t specify how much will be allocated for malaria.

“I don’t have a specific figure for malaria alone …[but] my belief is because under this year’s budget ... 10 percent of the national budget was allocated to health. And that 10 percent means that our plan to implement was fully funded. There was no gap in the allocation for my department. And so in terms of the malaria program … we have the right level of funding to buy the right amount of rapid diagnosis, ACTs, and also with the support of the Global Fund, distribution of LLINs,” he said.

This year, data provided to Devex from PNG’s National Health Information System shows some 1 million rapid diagnostics tests have been distributed, and half a million ACTs — with support from the National Department of Health and through Global Fund grants. Current RDT and ACT stocks are at 1.6 million and 489,000, respectively.

“With this small spike, I, as minister, have signaled that we will continue to need the Global Fund. Whether it’s in immunization or whether it’s malaria control, or TB and HIV/AIDS. Those are the three areas that we are now in discussion phase, at least to give special attention [to] during the transition phase of Papua New Guinea,” he said.

That support, however, may well be dependent on a fully-replenished Global Fund, according to an official who works with governments and donors, who spoke on condition of anonymity

“It's not that the Global Fund wants to transition out of countries that are in fiscal crisis. It's that they are having to make difficult decisions [given their] limited envelope,” the official told Devex.

The solution to the crisis however does not rest on the government alone, the official said.

“Part of the solution to this problem is of course in Port Moresby and part of [it] is in Canberra,” the source said.

Australia should show leadership not only in lobbying for strong replenishment of the Global Fund, but also in using its position to ensure the fund continues to prioritize funding in Asia-Pacific. The source said Australia’s contributions to the Global Fund gives them a seat at the decision table, and that gives them negotiating power for the Global Fund to “stay” in the region.